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HRT: doctors demand talks with government to tackle “chaos” of shortages

BMJ 2020; 368 doi: (Published 07 February 2020) Cite this as: BMJ 2020;368:m523

Rapid Response:

Re: HRT: doctors demand talks with government to tackle “chaos” of shortages. Another option ?

Dear Editor,
Richard Fleming’s interesting suggestion that some HRT prescribing may reflect what options are available to the prescriber, rather than what is best for the symptomatic woman, (1) is reaffirmation of Ellen Grant’s safe therapeutic suggestions, which depend on case by case analysis. (1)
Baum’s irritation that anyone should question the safety of HRT prescribing is understandable, it follows from his concern for symptomatic women. (1)
Half a century of HRT, innumerable indefinite trials and the occasional meta analysis, allow the conventional prescriber considerable latitude, but leave innumerable women concerned about their safety and their symptoms, which are often severe and disabling.
The variability of menopausal symptoms, psychological and physical, cry out for an individualised remedy that can be matched to the strange, rare and peculiar symptoms that careful history taking will often identify. Profuse perspiration localised to the cubital fossae ?
Homeopaths generally enjoy the treatment of menopausal women. Their individualised treatment is usually effective, completely safe, and brief - compared to years of HRT.
How depressing that so many medical professionals are trapped in that reductionist, mechanistic mode, so elegantly described by McGilchrist.
What would happen, McGilchrist wonders, if our left cerebral hemisphere become even more dominant ?
“ Knowledge that came through experience, and the practical acquisition of embodied skill, would become suspect, appearing either a threat or simply incomprehensible. It would be re[placed by tokens or representations, formal systems to be evidenced by paper qualifications. The concepts of skill and judgement, once considered the summit of human achievement, but which come only silently with the business of living, would be discarded in favour of quantifiable and repeatable processes. “ (2)

2 Iain McGilchrist, The Master and his Emissary, Yale 2009, p429.

Competing interests: Peripatetic homeopath, NHS, and abroad, many decades. Never for profit.

17 February 2020
Noel Thomas
retired / part time GP
Bronygarn, Maesteg, Wales CF34 9AL